An Amulet to Say "Big is Not Enough".

We report the case of a man affected by non-valvular atrial fibrillation in whom a severely enlarged left atrial appendage with a narrow neck was successfully closed with a 34 mm Amplatzer Amulet device (St. Jude Medical). In the presence of a huge appendage with a narrow neck, as in this case, the Amulet should be considered an available option to ensure the feasibility of percutaneous closure.

[Remarks on polyparametric assessment of sudden death risk for primary prevention ICD implantation in patients with left ventricular dysfunction of ischemic and non ischemic etiology. Italian Association of Hospital Cardiologists (ANMCO) Experts Position Paper].

It is generally recognized that current guidelines, based on ejection fraction criteria, do not allow appropriate selection of patients for implantable cardioverter-defibrillator (ICD) therapy in the primary prevention of sudden death, thus hindering the optimal use of ICD in patients with left ventricular dysfunction of ischemic and nonischemic etiology. Ejection fraction alone has limitations in both sensitivity and specificity. Assessment of the risk for sudden death using a combination of multiple tests (ejection fraction associated with one or more different arrhythmic risk markers) could partially compensate for these limitations.

Influence of Age and Gender on Complications of Catheter Ablation for Atrial Fibrillation.

Background: Despite catheter ablation (CA) has become an accepted treatment option for symptomatic, drug-resistant atrial fibrillation (AF), safety of this procedure continues to be cause for concern.

Objective: Aim of the present multicenter study was to assess the influence of age and gender on incidence and severity of early CA complications.

Methods: From January 1, 2011 to December 31, 2011, data from 2,323 consecutive patients who underwent CA (mean age 59.

Low incidence of permanent complications during catheter ablation for atrial fibrillation using open-irrigated catheters: a multicentre registry.

Aims: Despite catheter ablation (CA) has become an accepted treatment option for symptomatic, drug-resistant atrial fibrillation (AF), the safety of this procedure continues to be cause for concern. The aim of the present study was to assess the incidence of complications with permanent sequelae of CA for AF using open-irrigated catheters in a contemporary, unselected population of consecutive patients.

Methods And Results: From 1 January 2011 to 31 December 2011, data from 2167 consecutive patients who underwent CA for AF using an open-irrigated catheter in 29 Italian centres were collected.

Fibroblast growth factor 23 and the bone-vascular axis: lessons learned from animal studies.

Calcification of arteries and cardiac valves is observed commonly in dialysis patients and represents a major determinant of the heightened cardiovascular risk observed during chronic kidney disease (CKD) progression. Recent advances from clinical and basic science studies suggest that vascular calcification should be considered a systemic disease in which pathologic processes occurring in the bone and kidney contribute to calcium deposition in the vasculature. Among the factors potentially involved in the vascular-bone axis dysregulation associated with CKD, there now is increasing interest in the role of the phosphaturic hormone fibroblast growth factor 23 (FGF-23).

Bilateral papillary muscle infarction in a chagasic patient.

We report a case of a 59-year-old patient diagnosed with chagasic cardiomyopathy, who manifested sudden heart failure while hospitalized, evolving to death due to cardiogenic and septic shock. Anatomical-pathological studies revealed infarction of the papillary muscles together with histological changes compatible with 48 to 72 hours of evolution. Pulmonary edema was considered the cause of death, probably related to mitral regurgitation of ischemic nature.

Excimer laser in acute myocardial infarction: single centre experience on 66 patients.

Background: Pulsed-wave ultraviolet excimer laser light at 308 nm can vaporise thrombus, suppress platelet aggregation, and, unlike other thrombectomy devices, ablates the underlying plaque.

Aim: To evaluate both safety and efficacy of laser ablation in patients presenting with Acute Myocardial Infarction (AMI) complicated by persistent thrombotic occlusion.

Methods: From May 2003 to October 2006, we enrolled 66 AMI patients (age 59+/-11 years; 57 men) presenting complete thrombotic occlusion of the infarct related vessel.

[Anemia and myocardial ischemia: relationships and interferences].

Of all the pathologies that cause a critical reduction in oxygen supply to the tissues, atherosclerosis is undoubtedly the most frequent. At the coronary level, ischemia causes a critical imbalance in oxygen supply and demand to the myocardium. Protracting this condition induces necrosis since, when the heart surpasses certain limits, it is incapable of modulating its metabolism in relation to the availability of energy substrates.

[Left internal mammary artery graft stenosis. Atherosclerosis, spasm or kinking?].

The internal mammary artery is the most frequently used bypass conduit for the left anterior descending coronary artery in patients treated with bypass surgery, with excellent long-term patency rates. However, the mammary artery may also be affected by functionally significant stenoses. Most stenoses of the mammary artery are secondary to the surgical procedure at the anastomosis site, but atherosclerotic lesions may also develop.

Prevention of thromboembolism in patients with mitral stenosis and associated atrial fibrillation: effectiveness of low intensity (INR target 2) oral anticoagulant treatment.

Mitral stenosis (MS) in association with atrial fibrillation (AF) is a clinical condition at high risk for systemic thromboembolism. Although oral anticoagulants greatly reduce the incidence of thromboembolism in these patients, the optimal intensity of treatment has never been tested in specific clinical trials, and current recommendations are derived from studies of nonrheumatic AF. In this study we tested the effectiveness of two different intensities.

[Current management of oral anticoagulant treatment].

In recent years oral anticoagulant therapy has been recommended to an increasing number of patients for the primary or secondary prevention of thromboembolic diseases. Optimal management includes patient's education, adequate laboratory and specific clinical control. In this review, together with basic knowledge, data from medical literature are used to provide guidelines and practical information for the management of these patients.

[Giant left atrial myxoma].

A 65 year-old man with dilated cardiomyopathy and long history of high blood pressure and a previous cerebral vascular accident had a giant left atrial myxoma as an echocardiographic finding.